Rate and Cause of Sudden Cardiac Death in the Young During the COVID-19 Pandemic and Vaccination

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RESEARCH LETTER
Rate and Cause of Sudden Cardiac Death in the Young During the COVID-19 Pandemic and Vaccination Monica De Gaspari , MD; Ugo Fedeli , MD; Mario Saia , MD; Elisa Carturan, PhD; Kalliopi Pilichou , PhD; Domenico Corrado , MD, PhD; Gaetano Thiene , MD; Stefania Rizzo , MD, PhD; Cristina Basso , MD, PhD C ardiovascular complications have been identified as consequences of COVID-19 infection and COVID-19 vaccines. 1,2Sun et al 3 showed an increase of >25% in cardiac arrest/acute coronary syndrome emergency calls in the 16-to 39-year-old population during January to May 2021, and they found a significant association with the rates of first and second vaccine doses.A statewide analysis of out-of-hospital cardiac arrest in young people in Australia did not demonstrate increased rates of overall out-of-hospital cardiac arrest, myocarditis causing out-of-hospital cardiac arrest, or unascertained out-of-hospital cardiac arrest during the COVID-19 pandemic or after the introduction of COVID-19 vaccines. 4These contrasting findings and mass media claims raised concerns about vaccine-induced cardiovascular side effects.Our aim was to compare sudden cardiac death (SCD) rates and SCD attributable to myocarditis in young people across defined time periods before and during the pandemic and in the vaccination period.
Mortality records of residents 1 to 40 years of age in the Veneto Region, northeast Italy, between January 2018 and December 2022 were collected at the Regional Epidemiological Center, preceding the COVID-19 pandemic, at the onset of pandemic before vaccine availability, and during both the pandemic and vaccine availability.Yearly mortality in 2020, 2021, and 2022 was plotted against mortality in 2018 and 2019, overall and by causes of death selected according to the International Classification of Diseases, 10th Revision.All the cases referred from autopsies of SCD occurring in people 1 to 40 years of age were studied according to a standardized protocol.
Sudden deaths are classified as SCD when the autopsy identifies a cardiovascular disease as the underlying substrate.When a cause of death is not found at autopsy including toxicology, death may be assumed to be SCD with normal heart. 5Data that support the findings of this study are available from the corresponding author on reasonable request.Analysis of mortality records is a mandatory activity of the Epidemiological Center; no Institutional Review Board approval and consent are needed.
The Veneto Region population 1 to 40 years ranged from 1 948 263 in 2018 to 1 868 987 in 2022.By December 2021, at least 1 vaccine dose was administered to 6% of people 5 to 11 years, 77% of those 12 to 19 years of age, and 84% of those 20 to 40 years of age.
In conclusion, our analysis did not demonstrate increased rates of SCD in young people both during the pandemic and after the introduction of COVID-19 vaccination.Causes of SCD in young people, including those who experienced SCD within 30 days of their COVID-19 vaccination, were consistent with prepandemic causes as established by rigorous autopsy, and no increase in the prevalence of myocarditis has been observed.